Individual
DR. JOSE MARIO D CUYEGKENG FONTANILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 EUREKA RD, ROSEVILLE, CA 95661-3027
(916) 784-5655
Mailing address
401 BICENTENNIAL WAY, SANTA ROSA, CA 95403-2149
(707) 393-4704
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
23108
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810013316
—
WV
Enumeration date
09/15/2006
Last updated
01/03/2025
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